A Strengths-Based Approach to IPS Supported Employment: Learning from Strengths Model Case Management Implementation and Impact on Employment Outcomes Rick Goscha, PhD California Institute for Behavioral Health Solutions October 3, 2018

What I want to convey Employment is an essential component to helping people build and re-build their lives Employment exploration begins day 1 of service not at the point of IPS referral Being strengths-based doesn’t always come natural in our systems of care IPS staff play an essential role in keeping strengths on the organizational agenda

Goal of the Strengths Model Help people build or re-build lives, beyond our systems of care, that bring meaning, purpose, and valued identity Help increase people’s ability to exercise power related to: * How they view themselves * How they interact with their environment

Intrapersonal Narratives Empowering Intrapersonal Narratives Goal of SMCM Entrapping Empowering Environmental Niches Entrapping

Examples of Entrapping Narratives I am just…… “I’m not worth anything” I don’t deserve better “I am incapable of…..” I can’t do it because of ……

The Strengths Assessment is about creating space For narratives of hope, recovery, and wellness to co-exist

What is the Strengths Model? An evidence-based practice that…. …combines concepts and principles of recovery, empowerment, and person/environment niches… …with practical tools, methods, and practice interventions… …to help people build or re-build lives worth living, beyond formal systems of care, that bring meaning, purpose, and positive identity.

Primary providers of Strengths Best fit: Community-based, direct service workers (i.e care managers, case managers, community support workers) Promising fit: Peer support, supported employment, supported education, supported housing Practical application: outpatient clinicians, crisis services, residential services

The Context of Strengths Model Work 11/29/2018 The Context of Strengths Model Work Recovery Meaning Purpose Identity

What People Want Safe place to call home Economic stability Role with meaning, purpose, and valued identities Connection to others Connection with the community To love and be loved Feel safe Support to stay well

The Context of Strengths Model Work 11/29/2018 The Context of Strengths Model Work Engagement Understanding Hope Alliance Tools/Methods Strengths Assessment Personal Plan Group Supervision Recovery Meaning Purpose Identity

Principles of the Strengths Model People have the capability to recover, reclaim, and transform their lives Focus is on strengths versus deficits The community is viewed as an oasis of potential resources The person is the director of the helping process The relationship with the person is primary and essential The primary setting for our work is in the community

Integrative Role of Strengths Strengths Model Outpatient Therapy Supported Employment/ Education Crisis Services Residential Services Medical Services

Compatibility of Strengths with other strengths-based, recovery-oriented approaches Strengths Model Cognitive Behavioral Therapy Motivational Interviewing Dialectical Behavioral Therapy Solution focused approaches Shared-decision making

10 Strengths Model Studies Competitive Employment Psychiatric hospitalization Housing Post-secondary education Symptoms Community involvement Social Support Social Isolation Quality of Life

Fidelity and Outcomes Competitive Employment

Types Of Strengths Qualities/Personal Characteristics Environmental Strengths Interests/ Aspirations Talents and Skills

Introducing Dean

Organization of the Strengths Assessment Seven Life Domains Three Temporal Orderings Encompasses both simplicity and complexity

Introducing Elizabeth

Overview of Elizabeth at the beginning of her road to recovery 33 year old, white, heterosexual woman Living with mother and step-father. Mostly isolated from community. Frequent hospitalization (7 times in one year)

Overview of Elizabeth at the beginning of her road to recovery Frequent calls to crisis services (suicidal ideation) History of childhood physical, sexual, and emotional abuse.

Overview of Elizabeth at the beginning of her road to recovery Only lived once on her own (lasted 5 months) Evicted from apartment and was homeless for two months Re-entered the hospital Returned to living with mom and stepfather

Where Elizabeth is now (five years later) Own apartment for five years Sings in a church choir Helps out occasionally at nursery during Sunday school classes Has a close friend at her apartment complex Has a dog

Where Elizabeth is now (five years later) Has been hospitalized twice in the past five years Calls the crisis line periodically (3-4 times a year) Still struggles at times with depression, disassociation, voices, and suicidal thoughts, although less frequent Is considering employment

What shifts created the environment to help Elizabeth recover? “I am not worth anything. Therefore, this is best life will ever be.” “A better life is possible.” Worker: “I am not sure she can live on her own.” “I’m nervous about it, but maybe she can do it.”“ “I’m nervous about it, but maybe she can do it.” Agency culture: “We have to be careful getting people excited about hopes and dreams that are unrealistic.” –and– “Taking risk is a liability for the organization.” “If people do not dream and take risks, there’s no way we can help them recover.” Hope

What shifts created the environment to help Elizabeth recover? “I’m just trying to cope. Others are making life difficult for me.” “I want my own place. I want to prove to myself and others I can do this.” “I want my own place. I want to prove to myself and others I can do this.” Worker: “Once you’re stable, we can try to work on a goal like getting your own place.” ““I’m not sure what it is going to take to achieve this goal, but if it is important to you, I will help you explore it and take steps to achieve it.” “I’m not sure what it’s going to take to achieve this goal, but if it’s important to you, I’ll help you explore it and take steps to achieve it.” Agency Culture: “Make sure every goal on the treatment plan meets the criteria for medical necessity.” “Make sure every goal on the treatment plan is clearly something the person is passionate about and then make sure your role in that goal meets the criteria for medical necessity” “Make sure every goal on the treatment plan is clearly something the person is passionate about and then make sure your role in that goal meets the criteria for medical necessity.” Meaningful and Important Goal

What shifts created the environment to help Elizabeth recover? “I am mentally ill.” “I’m a singer, a friend, a daughter, a member of a faith community, who also struggles at times with distressing thoughts.” “I’m a singer, a friend, a daughter, a member of a faith community, who also struggles at times with distressing thoughts.” Worker: “She is mentally ill.” “I’m a singer, a friend, a daughter, a member of a faith community, who also struggles at times with distressing thoughts.” “She’s a singer, a friend, a daughter, a member of a faith community, who also struggles at times with distressing thoughts.” Agency Culture: “We serve people with severe and persistent mental illnesses.” “Make sure every goal on the treatment plan is clearly something the person is passionate about and then make sure your role in that goal meets the criteria for medical necessity” “We help people with the lived experience of mental illness build and/or rebuild lives that have meaning and purpose.” Identity and Focus

Critical Components of the Strengths Assessment (Content) Written in a context that is meaningful and important to the person “I want my own place. I want to prove to myself and others I can do this.” “I want my own place” “I would like more friends to do things with” Hope-inducing for the person ““I’m not sure what it is going to take to achieve this goal, but if it is important to you, I will help you explore it and take steps to achieve it.” The process of exploring possibilities and visualizing tangible strengths created an aura of hope Thorough, detailed and specific * Brother (Roy) can take me places if I need anything * Lamictal helps with the depression – “I don’t feel suicidal as much” Written from the person’s perspective and using his/her own words “I want…” “I have…..”

Critical Components of the Strengths Assessment (Process) Evolves at the person’s pace As opposed to a rush to fill out paperwork Most important is that person is engaged ` Conducted in a conversational manner ““I’m As opposed to an interview Uses the boxes to record, not guide Occurs in the person’s natural environment whenever possible As opposed to a majority of meeting occurring in the office The nature of the goal will often dictate setting Part of an ongoing process in which information is updated on a regular basis As opposed to a one-time assessment You are creating a portrait or building a narrative, not completing a form

Thank You!